Altered Mood Medications

Question 1

What is the MOA for SSRIs?

Answer 1

Selectively inhibit reuptake of serotonin (5-HT) from the synaptic cleft.

Question 2

Name 3 SSRIs and possible SEs

Answer 2

Fluoxetine, sertaline, citalopram.

GI upset, agitation, anxiety, insomnia, sexual dysfunction.

Question 3

Which SSRI is safest in those with epilepsy?

Answer 3

Citalproam

Question 4

What is the MOA for TCAs?

Answer 4

Block the reuptake of monoamines (mainly NA and 5-HT) into presynaptic terminals.

Question 5

Name 4 TCAs and 2 reasons why they are not typically 1st line

Answer 5

Amitriptyline, clomipramine, imipramine, dosulepin.

1) Cardiac SEs
2) Dangerous in OD

Question 6

At what time of day should TCAs be taken?

Answer 6

Before bed; due to sedating effect (opposite true for SSRIs).

Question 7

What is the MOA for MAOi?

Answer 7

Reversibly or irreversibly block MAO-A & B, which has an important role in breaking down metabolites.

Question 8

Describe the relationship between tyramine and MAOi

Answer 8

1) Tyramine is a potent releaser of norepinephrine (NE).
2) MAO-A normally breaks down NE.
3) When blocked; NE accumulates after a high tyramine meal.
4) Hypertensive crisis ensues.

Question 9

Name some food/drinks high in tyramine (6)

Answer 9

Cheese, dried/smoked meats, stock cubes, pate, alcohol (particularly red wine), black pudding.

Question 10

What is the MOA for SNRIs?

Answer 10

Block the reuptake of monoamines (NA and 5-HT) into presynaptic terminals.

Question 11

Name 2 SNRIs

Answer 11

Venlafaxine, duloxetine.

Question 12

When would mirtazapine possibly be used first line?

Answer 12

If the patient is suffering from insomnia and/or poor appetite.

Question 13

What is the mainstay of BPAD treatment?

Answer 13

Lithium carbonate

Question 14

Name some drug interactions of Lithium carbonate

Answer 14

NSAIDs, ACEi, ARBs, diuretics

Question 15

Monitoring is required throughout Lithium use; which 3 tests are carried out prior to initiations?

Answer 15

U&Es, TFTs, ECG

Question 16

What is the MOA of sodium valproate?

Answer 16

Blocks the voltage sensitive Na+ channels, increasing levels of GABA

Question 17

Name some SEs of sodium valproate (6)

Answer 17

Sedation, tremor, dizziness, weight gain, GI upset and teratogenicity.

Question 18

Which drug is used in prophylaxis of BPAD and has a similar MOA to sodium valproate?

Answer 18

Lamotrigine

Question 19

For patients taking lamontrigine, which SE should encourage them to seek immediate medical attention?

Answer 19

Rash; risk of Stevens Johnson syndrome.

Question 20

Name some atypical antipsychotics (4)

Answer 20

Olanzapine, risperidone, quetiapine, amisulpride

Question 21

Name some typical antipsychotics (4)

Answer 21

Haloperidol, chlorpromazine, zuclopentixol, flupentixol